Jacky Luiten

34 | Chapter 3 Abstract Introduction We evaluated the use and value of breast surgical excision biopsies for diagnostic purposes over the last decades in women undergoing mammographic screening, either as a primary procedure or following an inconclusive percutaneous biopsy. Methods All women who underwent an excision biopsy among 817,656 screens, obtained from January 1997 to January 2017, were included. Results Of 18,593 recalled women (recall rate, 2.3%) with screen‐detected abnormalities, 908 (4.9%) underwent an excision biopsy. Of these, 411 (45.3%) were performed as first diagnostic intervention, decreasing from 4.3 per 1000 screens in 1997‐1998 to 0 per 1000 screens in 2015‐2016 and onwards. The remaining 497 (54.7%) excision biopsies were performed secondary to pathologic findings at percutaneous biopsy. During 1997‐1998, 1.0 secondary biopsies per 1000 screens were performed, decreasing to 0.3 per 1000 in 2005‐2006 and afterwards increased to 0.6 per 1000 in 2015‐2016 ( p =0.003). Of all 487 secondary biopsies, 303 (61.0%) had a benign pathology outcome, increasing from 40.4% in 1997‐1998 to 70.2% in 2015‐2016. Of all 211 biopsies in the three most recent cohorts (2011‐2016) the overall upgrade rate was 26.5%, consisting of 39 (18.5%) DCIS (27 low grade) and 17 (8.1%) invasive carcinomas. Conclusion Although the use of excision biopsy significantly decreased over the past two decades, we observed a significant increase in more recent years. Since the vast majority of currently performed excision biopsies reveals a benign diagnosis or shows low grade DCIS, a secondary excision biopsy should only be considered if radiologic surveillance and repeated percutaneous biopsy continues to yield indeterminate results.